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CONTRACTOR EMPLOYEE BIOGRAPHICAL DATA SHEET 1. Name (Last, First, Middle) PANDEY, SANJAY, KUMAR 3. Employees Address (include ZIP code) C-702, PNB APARTMENT, PLOT: 11, SECTOR 4, DWARKA, NEW DELHI - 75 PIN: 110 075
8. Telephone Number
(include area code)
2. Contractors Name Population Foundation of India, New Delhi 4. Contract Number 6. Proposed Salary 5. Position Under Contract 7. Duration of Assignment
011-45610212/ 098781648844
11. Names, Ages, and Relationship of Dependents to Accompany Individual to Country of Assignment 12. EDUCATION (include all college or university degrees)
MAJOR DEGREE DATE
13.
LANGUAGE PROFICIENCY
(See instructions on reverse)
LANGUAGE
Proficiency Speaking
Proficiency Reading
5 5 5
5 5 5
EMPLOYMENT HISTORY
1. Give last three (3) years. List salaries separate for each year. Continue on separate sheet of paper if required to list all employment related to duties of proposed assignment. 2. Salary definition - basic periodic payment for services rendered. Exclude bonuses, profit-sharing arrangements, commissions, consultant fees, extra or overtime work payments, overseas differential, or quarters, cost of living or dependent education allowances. POSITION TITLE EMPLOYERS NAME AND ADDRESS POINT OF CONTACT & TELEPHONE NUMBER
Dates of Employment (M/D/Y) From To
Annual Salary Dollars
May , 2008
February 2, 2009
$3,000/mo nth+Tel. at Residence (Rs. 6000/mont h) +Vehicle (Rs.10000/ month) on reimburse ment $2,000/mo nth+Tel. +Mobile+in ternet at Residence (Rs. 5000/mont h) +Vehicle (Rs.8000/ month) on reimburse
JUL. 3, 2006
April, 2008
ment EXECUTIVE DIRECTOR STATE PROGRAMME REPRESENTATIVE PROGRAM OFFICER JHARKHAND HEALTH SOCIETY, RCH DIRECTORATE, NAMKUM, RANCHI CARE, 381 A, ROAD NO. 4, ASHOKNAGAR, RANCHI JUNE 1, 2005 FEB.15, 1999 MARCH, 1996 JULY 2, 2006 MAY 31, 2005 FEBRUA RY, 14, 1999
15.
SERVICES PERFORMED
16.
CERTIFICATION: To the best of my knowledge, the above facts as stated are true and correct.
Date
Signature of Employee
SANJAY KUMAR PANDEY, Ph.D. 17. CONTRACTORS CERTIFICATION (To be signed by responsible representative of contractor) Contractor certifies in submitting this form that it has taken reasonable steps (in accordance with sound business practices) to verify the information contained in this form. Contractor understands that USAID may rely on the accuracy of such information in negotiating and reimbursing personnel under this contract. The making of certifications that are false, fictitious, or fraudulent, or that are based on inadequately verified information, may result in appropriate remedial action by USAID, taking into consideration all of the pertinent facts and circumstances, ranging from refund claims to criminal prosecution. Signature of Contractors Representative Date
AID 1420-17 (9/94)